Tag Archives: hospital revenue

Revenue lost due to patient leakage in hospitals and health systems

The last few years have been a tumultuous time for hospitals and health systems due to the high patient leakage rate. Even today, patient leakage is a key concern and remains an unsolved challenge in many of the health systems. Health systems are losing more than 20% revenue due to inefficient organizational referral processes, as a result, patients are opting to different care providers for their care needs. Identifying the gaps or latitude to go out of the system, and sealing this, is the basic step that health systems need to take in solving patient leakage challenge.

What are the main causes of patient leakage?

Here are some reasons why patient leakage happens

– Referring physicians refer patients to out-of-network providers

– Patients move out of the care network due to poor care coordination

– Unavailability of a specialist within the care network

Patient Leakage and its consequences

Though in most hospitals patient leakage is contributing to significant revenue loss, this loss is ignored, and not given much importance. Health systems and hospitals need to consider this leakage extremely important. Non-coordinated or fragmented care is one of the main reasons for patient leakage. The point is to emphasize on some damaging consequences patient leakage can bring on care quality and patient health outcomes.

Understanding the actual causes of this leakage and taking tangible steps to address this challenge is vital. It is the responsibility of the health system to track and manage patient referrals in a better way with a solution for tracking leakages and referrals. Otherwise, it can damage the health system’s reputation, undermine its brand value, and even jeopardize its competitive edge.

Challenges in processes that cause patient leakage

Streamlining different processes for different aspects is required for better overall operational efficiency. One such process that needs attention to arrest leakage is the patient referral process. Health systems need to adapt to solutions that will help seal this leakage. HealthViewX helps referral coordinators in health systems to manage patient referral efficiently and improve care, performance, compliance, and reduce leakage.

The current referral process lacks certain mechanisms to make this process effective. Hospitals and health systems need a referral solution in addition to an EMR to solve their referral challenges especially referral leakage.

An ideal referral solution for hospitals should have the following features

Multi-channel referral consolidation

Health systems have multiple access points for patients and chances are that health systems may miss following-up with some referrals. The solution needs to consolidate referrals from multiple sources like fax, email, phone calls, online forms, etc. It should integrate well to bring all of these referrals into one single queue and ensure not a single referral is missed.

Secure exchange of information

A HIPAA compliant solution that supports the secure exchange of sensitive patient information among the care providers involved in patient care is a must. The provider should be able to attach documents securely at any time for one another’s reference.

Patient referral history

Both the referring physician and the receiving provider should have access to the entire referral history. All required information right from the time a referral is initiated and consequent diagnosis reports, referral status, etc. should be available at any point of care.

Scheduler Integration

Patient convenience is one of the most important factors in providing care. Scheduling appointments as per patient convenience and automated reminders for both patient and provider about the appointment is mandatory.

Dashboard and referral insights

The solution has to give complete data of the referrals flowing into the health system. The number of referrals processed, number missed and many more as per the requirement of the health system. These data analytics should give the practice a clear picture of how referrals are handled and where the leakage is happening.

Speak to HealthViewX solution experts to understand more about HealthViewX Referral Solution features that will help solve some of the challenges in the patient referral process and increase revenue through effective tracking. Schedule a demo today!

Referral Management Solution Is The Need Of The Hour For Large Hospitals

With the ever-evolving healthcare setting and exponential developments in health IT, many choices need to be made by hospitals/health systems to provide their patients’ with quality care. Health systems are struggling to manage their clinical, operational and monetary challenges. Most importantly, it is necessary to orchestrate care teams’ workflow movements to be able to demonstrate meaningful use. This is the key to improving patient care and the ability to make better-informed decisions. A lot of providers are already adapting to smarter and new healthcare technologies to shape the future of healthcare.

Factors like sustainability, patient-centricity, care delivery, HIPAA compliance, digital health technology, etc. should be kept in mind before choosing any IT solution. Referral Management Solution is one such solution that is the need of the hour and it has to be chosen with utmost importance. Moving from volume-based to value-based care model will require building a solution to manage higher patient referral volumes, to ensure patients’ receive care within their referral network, track referrals, close referral loops, study dashboards and analytics for meaningful use, etc.

There are a lot of benefits a referral management solution can bring to referring physicians, patients and receiving physicians: that includes, improved operational efficiency, reduced referral leakage, increased referral loop closures, increased revenue and patient satisfaction.

There are several other reasons why a referral management solution is required to manage patient referrals. Hospitals face numerous challenges in their referral process such as operational inefficiency, improper communication among providers, lack of coordination, missed referral loop closures, increased no-show rates, time consumption, etc.

Below are some alarming stats that show the need for a referral solution for hospitals

46% of faxed referrals never result in a scheduled appointment.
55% of specialist visits are unnecessary.
There is an annual leaked income of $900k per physician employed.
50% of referring physicians do not know whether their patients actually see the specialist.

In addition, hospitals participate in passive referral management:

Physician informs the patient about the need to see a specialist.
Referral coordinators may not reach out to the patient to get an update to see if the patient had visited the specialist.
Follow-up or update from the customer is completed only during the next visit.

Active referral management enables both provider and patient-driven processes to be managed by referral coordinators. It ensures maximum efficiency, finds the right provider for the patient, identifies referral patterns, improves stakeholder communication, reduces referral leakage, decreases lead time, improves completion rates, ensures closure of the referral loop and satisfaction of the patient.

Pitfalls in choosing the right Referral Management Solution:

Even though there are different referral management software with an array of features in the market, it often becomes frustrating to choose the right solution for your hospital. So before zeroing in on the solution, a detailed analysis of your current challenges in the patient referral process has to be carried out. Later mapping to the required features of the solution will be the best choice.

Health Systems need an end-to-end interoperable referral solution to track their patient referrals throughout the process until the referral loop closure. The solution should streamline and enable seamless communication among all stakeholders’ involved in-patient care.

Some of the benefits you can see when using patient referral software are

For the providers:

Reduce referral leakage and improved operational efficiency
Seamless communication
Multi-channel integration
Manage and track referrals
Meaningful engagement
Effective diagnosis and treatment

For the patients:

Prompt diagnosis
Save time and money
Better outcome

HealthViewX Referral Management Solution was created with the potential to solve all the challenges faced by enterprise hospitals in their referral process.

HealthViewX Referral Management Solution helps to send and receive referrals securely and seamlessly, provide quick access to patient data, fix appointments, send notifications and alerts, and share information throughout to ensure closure of referral loop. A 30-minute demo with our team will help you know how effective our solution can track and manage the referral life cycle. To know more schedule a demo with us.

5 Benefits To Look For Before Choosing A Referral Management Software

Referral process in healthcare

A referral process in healthcare, a primary care physician creates a referral order in the EMR for a patient to see a specialist or imaging center for a specific medical service. PCPs hold the responsibility for managing and tracking their patient referrals throughout its life cycle. But the PCPs face challenges in managing the referral process. Challenges such as increasing patient referrals, new specialist and imaging centers opening up, manual referral follow-ups, etc prevent PCPs from managing the referral process effectively. This is when a healthcare referral management system comes to play.

Importance of referral management software in healthcare

There are many reasons for why having a referral management software is necessary. Healthcare processes are always criticized for being costly and inefficient. Referral management software is a potential solution to the healthcare problems. In this day and age, healthcare is moving towards improving quality and efficiency, while also decreasing the cost. It’s all about improving the experience for their patients. The entire industry is adapting technology for streamlining administrative operations.
Here are some alarming statistics that reiterate the need for a referral management solution,

Any health system will have an average referral leakage of 55-65%
Approximately 33% of patients do not follow-up with the specialist to whom they are referred
25 to 50% of referring physicians do not know whether their patients see the specialist
Over 50% of the current referral process is redundant and repetitive

In order to reduce referral leakage, increase patient follow-ups and improve the current referral process, a referral management software is needed.

Benefits a referral management software should deliver

The following are the benefits that a referral management software should deliver in order to make the referral process efficient,

1. Reduced referral leakage

Referral leakage is a huge problem hemorrhaging health systems in the country. Missed referrals are the main reasons for millions of lost revenue.
After implementing an effective referral management solution, the health system will see an immediate reduction in referral leakage. It will have a positive impact on the health system by making it more efficient and better equipped to serve patients. The immediate effect a health system will recognize is fewer patients leaving the health system thus saving millions in lost revenue.
Click here to learn more about how a health system can reduce referral leakage in their network.

“HealthViewX reduces referral leakage by helping referral coordinators in identifying the right receiving providers within the care continuum”

2. Decreased lead times

Operational inefficiency hampers a referral network to a greater extent. Dead time or unnecessarily long lead times are an inconvenience to both patients and providers alike.
For eg – PCPs frequently refer patients to specialists without considering the benefit for the specialty. About 65% of referral created by PCPs are unnecessary. These unnecessary visits will lead to long waiting times for those who do need to see a specialist. This will in turn result in poor health outcomes.
These problems can be solved by investing in a referral management solution. It will make the process efficient, decrease lead times, shorten patient waiting times and improve patient satisfaction. Increased operational efficiency will lead to shorter patient waiting times and thus more patients being seen.

“HealthViewX improves operational efficiency by automating the primary care to specialist referral process in healthcare”

3. Improved referral closure rates

With a referral management system in place, it is easy to track referrals depending on the status. Improved referral tracking leads to increased referral loop closures.

“With HealthViewX Patient Referral Management Software, health systems can track referrals in real-time. It provides a timeline view that helps referring and receiving physicians to know in which status the referral is.”

4. Improved referral utilization

Tracking patients’ progress through the care continuum helps to improve utilization for both providers and staff. Referral Management Software will enable health systems to see more patients.
PCPs can easily send patients to specialists by searching through directories and evaluating providers based on reviews, quality, and even familiarity.
It’s even better when this whole process can be condensed into one application, allowing both doctors and staff alike to access provider directories.

“HealthViewX Patient Referral Management supports features such as Intelligent Provider Match and Online Scheduling. It enables better utilization of the existing staff in health systems.”

5. Additional patient time

Finally, and maybe most importantly, referral management software must save time on administrative processes. This will increase the time for the actual medical visit.

Reference
https://www.mass.gov/files/documents/2016/08/uy/2011-hcctd-full.pdf
https://www.beckershospitalreview.com/payer-issues/3-important-statistics-about-provider-referrals.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160594

How Can Price Transparency Impact The Healthcare Industry?

Patient financial responsibility is the greatest challenge of healthcare industry. For a long time, healthcare experts have argued that price transparency will help patients in making informed healthcare decisions thereby decreasing healthcare costs.

In August 2018, CMS stated in its updates to the Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH PPS) final rules that price transparency will become a nationwide industry standard.

With effect from January 1, 2019, hospitals across the country are responsible for full price transparency. As per the IPPS and LTCH PPS rules, hospitals must list their prices online in a “machine-readable format.”

CMS approach to enforcing price transparency

Previously, hospitals were required to make their prices publicly available, but not necessarily in a digital format. In the new rule, CMS has mandated that these new price transparency resources be in a machine-readable format. CMS analyzed public comments on the most efficient way to achieve this. Finally, CMS called on all hospitals to list their chargemaster prices on a publicly-available Excel spreadsheet. The searchable spreadsheet will make it easier for patients to use.

Hiccups in the existing approach by CMS

Many questions have been raised about this approach.

Critics claim that charge master prices are not ideal for patients. Between insurance, subsidies, and other payment design, patients usually pay less than chargemaster price.
The feasibility of an Excel spreadsheet having all prices is a big question.
As more organizations publish their price transparency lists, more difficulties may come to light.

How can price transparency help patients?

Digital price transparency will enable patients to more easily access this information.
Price transparency will enable patients to make more informed decisions about care access that minimize their out-of-pocket costs and total expenditures borne by Medicare and Medicaid.
Increased price transparency will improve the patient experience of care.
Although price transparency itself cannot lower healthcare costs, but it may create market pressure that in turn lowers patient costs.
Additionally, price transparency will allow patients to choose the best care option for their needs.

The healthcare industry is still debating about the efficacy of price transparency. Healthcare price transparency tools have already made their mark in the healthcare industry. Do such tools improve patient experiences with healthcare or cut costs? How can organizations reconfigure these tools to increase its effectiveness?

Can price transparency reduce healthcare costs?

According to a 2016 study published in Health Affairs, it was found that price transparency tool actually increased out-of-pocket outpatient spending by about $59 per patient. The researchers suggested that it must must have been due to low patient awareness or perceived need of the tool.

Moreover, cost compare tools did not show many meaningful areas for cost savings.

Other studies have also shown similar results. A 2017 report by the American Journal of Managed Care found that though patients liked the idea of a cost comparison tool, they saw little use of the tool. They either forgot to use the tool before seeking care or did not see any use because they were already beyond their deductible or saw consistent copayments at their doctor’s office.It also touched on the idea of patient loyalty. Although patients could use price transparency tools to find a less expensive care option of equal quality, a sense of loyalty kept them going to their current clinicians.

Payers who offer price transparency tools have also had little luck with the tools. A 2017 report published by Health Affairs found that although scanning a cost compare website could result in 14% cost cuts for imaging services, only 1% of patients actually use the tool, making it of little use.

What do industry professionals say?

Although price transparency tools are not currently impacting the rising healthcare costs, these tools still have the potential to reduce spending and improve patient experience.

If properly utilized, cost compare technology should help patients cut their own healthcare spending because they know the lower-cost providers to visit. Patients with access to a price transparency tool have the opportunity to compare cost and quality and make their preferred treatment selection based on that data. Ideally, this will lead patients to a lower-cost option.

Clinics have little incentive to lower their costs when patients do not know how much they’ll pay before they receive the service. But if all clinics knew patients were visiting a high-quality facility with substantially lower costs, area competitors could be forced to change their prices, as well.

How can organizations make price transparency work?

Making price transparency tools that are attractive and usable for patients will be critical for delivering on the promise of cost compare. Simply offering a price transparency tool will not lower costs. Patients must actually use these systems to select lower-cost care.

As the healthcare industry continues to place more financial burden on patients, it will need to adopt strategies that help patients. High copay and high-deductible health plans have put patients in the role of the healthcare consumer. Price transparency tools are a key retail-style engagement strategy that will help consumers make better decisions about where to access care.

But in order to make those price transparency tools effective, industry leaders must keep the patient at the center of their design. Making a usable cost compare tool that uses simple language and factors in metrics that are important to patients will be integral going forward.

Reference

https://patientengagementhit.com/news/myhealthedata-patients-over-paperwork-key-in-cms-final-rules

https://jamanetwork.com/journals/jama/fullarticle/2518264

https://patientengagementhit.com/news/price-transparency-tools-receive-tepid-patient-reactions

https://patientengagementhit.com/news/4-patient-engagement-strategies-to-improve-patient-retention

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2016.1636

A Leading FQHC In California Chooses HealthViewX To Manage Their End-To-End Referral Process

About the Federally Qualified Health Center

Federally Qualified Health Center (FQHC) in the United States is a non-profit entity comprising of clinical care providers, that operate at comprehensive federal standards. The care providers in FQHC are a part of the country’s health care safety net, which is defined as a group of health centers, hospitals, and providers who are willing to provide services to the nation’s needy crowd, thus ensuring that comprehensive care is available to all, regardless of income or insurance status. This client is the health care safety net for their county’s poor and uninsured people. The FQHC gives the people access to high-quality health services that they needed and deserved. They are key regional health providers who treats more than 65,000 patients annually.

Challenges in the existing referral workflow of HealthViewX Federally Qualified Health Center client

The following are the major problems our Federally Qualified Health Center client wanted a solution for. Let us consider the challenges with a typical referral scenario to understand it better.

Insurance pre-authorization – The physician must check the pre-authorization requirements, health plans, etc. He must retrieve patient-specific data like the history of medications, medical diagnosis and insurance coverage. The physician must then send it to the insurance company so that they can validate the same. This client did not a dedicated team or software to do insurance pre-authorization which increased their burden.
Tracking the referral – Specialists are usually busy. They do not have the time to inform physician’s about the progress of referrals. So the physicians are unable to track referrals. They get no information about appointments, referral loop closure or feedback from specialists or patients.

How HealthViewX features helped this FQHC client resolve their challenges

Considering the existing workflow of the FQHC, their major problems are insurance pre-authorization and referral tracking. So how can HealthViewX Patient Referral Management solution help in solving these problems?

The following features made the pre-authorization and referral communication easier for this FQHC client,

EMR/EHR integration – Our System integrates directly with electronic health records (EHRs). This enables healthcare professionals to easily obtain prior authorizations in real time at the point of care. It also eliminates time-consuming paper forms, faxes, and phone calls.
Insurance pre-authorization automation – There are two ways in which HealthViewX solution automates the insurance pre-authorization process. The first one is the api-based method. Through this, we retrieve information regarding the forms and communicate information back and forth between the FQHC and the insurance company. The second one is the form automation method. Through this, we get all payer-specific form, fill in the necessary information and send it to the insurance company via efax
To and fro Communication – At any time of the referral process, the PCP and the center can communicate with the help of the inbuilt secure messaging and voice call applications. By this, the physicians can get referral updates easily.

Useful HealthViewX Patient Referral Management Solution features

Leading FQHC in California has chosen HealthViewX due to the industry-leading patient referral management features. FQHCs across USA can benefit from Referral Management Software depending on their patient referral workflow,

Intelligent Provider Match
HIPAA compliant data security
Referral history
Referral loop closure

HealthViewX Patient Referral Management software has provided the best use cases for the major challenges faced by the FQHC. Are you a Federally Qualified Health Center missing out on your referral updates? Schedule a demo with us to know more about our solution.

How can Federally Qualified Health Centers Ensure The Progress Of Patient Referrals?

Federally Qualified Health Centers are community-based health care providers that receive funds from the HRSA Health Center Program to provide primary care services in underserved areas. They must meet a stringent set of requirements, including providing care on a sliding fee scale based on ability to pay and operating under a governing board that includes patients.

The scope of services of a Federally Qualified Health Center

Basic Health Services
- Health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology that are furnished by physicians and where appropriate, physician assistants, nurse practitioners, and nurse midwives;
- Diagnostic laboratory and radiologic services;
- Preventive health services
- Emergency medical services
- Pharmaceutical services as may be appropriate for particular centers
Referrals to providers of medical services and other health-related services;
Patient case management services (including counseling, referral, and follow-up services) and other services designed to assist health center patients in establishing eligibility for and gaining access to Federal, State, and local programs that provide or financially support the provision of medical, social, educational, or other related services;
Services that enable individuals to use the services of the health center (including outreach and transportation services and, if a substantial number of the individuals in the population served by a center are of limited English-speaking ability, the services of appropriate personnel fluent in the language spoken by a predominant number of such individuals);
Education of patients and the general population served by the health center regarding the availability and proper use of health services
Telehealth/Remote long-distance health services
- The CARES Act that has been established in response to the COVID-19 pandemic authorizes FQHCs to provide telehealth services
- This act removes the previously existing barriers that restricted the scale of services that physicians and practitioners could exchange to patients remotely
- Price has been set at $92 for claims with the code G2025

Patient Referral Program in a Federally Qualified Health Center

Federally Qualified Health Centers constitute Primary Care Providers (PCP) who serve the underserved population. FQHCs are high outbound referral setups i.e they send out numerous referrals. A patient visits the clinic when he/she is suffering from an illness. Depending on the severity, the physician might refer the patient to an imaging center for further diagnosis or a specialist practice for advanced treatments.

An FQHC is recommended to have a dedicated referral coordination team to send out referrals and ensure effective referral coordination. With the help of the patient demographics and diagnosis details, the referral coordinator reviews the insurance prior authorization and finds the right imaging center or specialty practice for the patient. Following that, the coordinator creates a referral that includes the details of patient demographics and the required diagnosis. Finally, the referral is sent to the relevant imaging center or specialty practice.

Challenges faced

The referral creation involves tedious manual work due to the following reasons.

Finding the right specialist/imaging center – Due to the increasing amount of imaging centers and specialists, it takes a lot of time and effort for the referral coordinator to narrow down the referral coordinator’s search and find the right one. It is also less likely for an FQHC to have the updated list of imaging centers and specialty practices.
Time Spent – As referrals are handled manually, a referring coordinator spends approximately half-an-hour to one-hour for creating a referral and even more time in following up.
No Updates – After a referral is sent, both the referring and the receiving providers may not be updated on the referral progress. In other words, the specialist/imaging center and the patient fail to update the clinic on the progress of the referral resulting in open referral loops.

Why are referral updates important to a Federally Qualified Health Center?

The patient’s well being – The primary role of a physician is to check on his/her patients’ health. Therefore, it is essential for a provider to know the status of the referral, the appointment, the patient’s condition, or illness.
Referral loop closure– Open referrals are a result of the referring provider not being updated on the referral’s progress. The ultimate aim of a referral process is to give the patient better treatment. Closing a referral loop is very important because it indicates that the patient was taken care of.
Data Analytics – PCPs require concrete data of how many referrals were converted to an appointment by a specialty care or an imaging center. It will help in analyzing who responds quickly and to whom the PCP can direct future referrals.
Referring to the right person – Depending on the progress of the referral and the patient’s feedback, the physician can get to know how good or bad the referral process has been. This will help the physician in knowing what step to take next.
Schedule follow-up appointments – After the referral is done, the physician has to schedule an appointment for the patient. For eg: If the physician is referring his patient to an imaging for X-ray, the physician must be notified once the test is done so that he can schedule an appointment and give treatment to his patient depending on the results. Structured appointments scheduled in a well-managed referral system is a constant source of new patient revenue.

Monitor your referral pipeline better with the HealthViewX solution

The major problem with an FQHC not getting updates is that everything is manual. A software solution can solve this problem quite easily. HealthViewX Patient Referral Management solution enables a referral in three simple steps thus providing a successful referral program. After the referral is created, it can be tracked with the help of the status. Both the referring and receiving providers will be notified of the appointments, test results, treatment recommendations, etc. HealthViewX can integrate with EMR/EHR and can also coordinate between the referring and the receiving sides. Any referral has a timeline view which is common to both the receiving and the referring providers. In the timeline view, history of the referral can be seen for eg: notes related to the patient’s health, previous status of the referral, etc. Documents attachment and status change can also be done at any time of the referral process. HealthViewX Patient Referral Management solution can allow providers to be updated on the progress of the referral. This helps providers simplify the referral process and close the referral loop.

HealthViewX Patient Referral Management solution helps the referring provider to track the referral progress. Schedule a demo with us and our patient referral management experts will guide you through our HIPAA compliant solution.